Talking to Your Doctor About Weight

When people come to talk to me about their weight, whether intentional or unintentional, I can take a wild guess at some of the statements they’ve heard from others, including doctors:

"Excess weight is bad for your health. It can lead to Type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, osteoarthritis and even cancer.”

“You need to lose weight,” a statement often devoid of concrete advice or strategies.

“If you had more willpower to eat less and exercise more, you’d lose weight.”

The bottom line: it’s not that simple. When people come to see me and doctors like me who take an interest in helping people lose weight, I keep in mind all these phrases and try to address them in the following ways:

First, I address their weight in simple terms. I don’t always state the weight itself; sometimes the “number” is too daunting. However, by bringing up the concept of weight with phrases such as, “Have you gained or lost significant weight in the last few months or years?” I find that patients are willing to talk more openly, which helps to persuade people to discuss their weight.

I ask about weight history, including their weight and development as children as well as their high and low adult weight; if there was a particular event such as an injury or life stressor (pregnancy and menopause are common ones) that coincided with weight gain’ how they’ve tried to lose weight (including programs medications, supplements they’ve heard about and exercise plans), what has been successful and more often, what has not.

It’s crucial for patients to understand how really difficult it is to lose weight and keep it off. People who have excess weight and have tried to lose it are aware of the challenges. Oftentimes, however no one has explained to them scientifically why this is often the case. Our bodies, to a large extent, are programmed to hold onto weight. This mechanism is both primitive (e.g. how our ancestors were able to survive during famine) and powerful (working from our gut to our brains and everything in between).

It’s important to discuss concrete weight loss goals and possible treatment options with patients. Metabolically speaking, particularly for blood sugar levels, losing 5% of body weight makes a difference. Incremental goals such as these are less daunting and therefore more achievable. Aside from counseling on non-medical changes such as nutrition plans or food logging, I do mention other treatment options. There are several weight loss medications that are approved and safe – all of which I discuss in detail. When appropriate, I talk about the option of bariatric surgery, which is a powerful tool for weight loss. Based on the individual, I make my recommendation for the best course of treatment.

My advice to patients, first and foremost, is to open up to your physician about your weight concerns. There is no need to be ashamed, or to feel as though you’re not trying hard enough. Remember, weight is not as black and white as numbers on a scale. With the appropriate plan and trusting medical team by your side, losing weight, and keeping it off, can be more than possible.